国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (6): 675-682.doi: 10.7518/gjkq.2021083

• 综述 • 上一篇    下一篇

外伤年轻恒牙的牙髓状态判断及治疗选择

郜慧慧1(),邓淑丽2,何新敏2,胡济安2()   

  1. 1.浙江大学医学院口腔系 浙江大学医学院附属口腔医院牙体牙髓科 浙江省口腔生物医学研究重点实验室 杭州 310006
    2.浙江大学医学院附属口腔医院牙体牙髓科 浙江省口腔生物医学研究重点实验室 杭州 310006
  • 收稿日期:2020-12-10 修回日期:2021-05-14 出版日期:2021-11-01 发布日期:2021-10-28
  • 通讯作者: 胡济安
  • 作者简介:郜慧慧,住院医师,学士,Email： 21818478@zju.edu.cn
  • 基金资助:
    国家卫生健康委员会科研基金(WKJ-ZJ-1624);浙江省教育厅一般科研项目(Y201942154)

Evaluation of pulp status and selection of treatment in young permanent teeth after trauma

Gao Huihui1(),Deng Shuli2,He Xinmin2,Hu Ji,an2()   

  1. 1. Dept. of Dentistry, School of Medicine, Zhejiang University, Dept. of Cariology and En-dodontics, The Affiliated Stomatological Hospital, School of Medicine, Zhejiang University, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, China
    2. Dept. of Cariology and Endodontics, The Affiliated Stomatological Hospital, School of Medicine, Zhejiang University, Key Laboratory of Oral Biomedical Research of Zhe-jiang Province, Hangzhou 310006, China
  • Received:2020-12-10 Revised:2021-05-14 Online:2021-11-01 Published:2021-10-28
  • Contact: Ji,an Hu
  • Supported by:
    National Health and Family Planning Commission Fund(WKJ-ZJ-1624);Zhejiang Education Department of General Scientific Research Project(Y201942154)

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摘要：

牙外伤是指外力造成的牙体硬组织和（或）根尖周组织的损伤,任何类型的牙外伤都可能会造成牙髓组织病理性改变,从而影响患牙的预后及长期保存,尤其是年轻恒牙,存在牙根发育不完全、根尖孔粗大、牙髓血供丰富等独特的解剖及生理学特点,这为其外伤后的牙髓治疗带来了巨大挑战,同时也为其活髓保存及牙髓再生提供了生理学基础。本文就年轻恒牙外伤后的不同牙髓状态及其相应活髓保存治疗方法作一综述,以期为口腔临床医生提供治疗选择的依据。

关键词: 牙外伤, 年轻恒牙, 牙髓状态, 活髓保存治疗

Abstract:

Tooth trauma is the damage of hard tissue and (or) periapical tissue caused by external force. It may induce pathological changes of dental-pulp tissue, thereby affecting the prognosis and long-term preservation of the affected teeth. In particular, permanent teeth have the unique anatomical and physiological characteristics of incomplete root deve-lopment, large apical foramen, and adequate blood supply. Once young permanent teeth suffer from trauma, the treatment of the affected teeth becomes greatly challenging. It also provides a physiological basis for the preservation of living pulp and pulp regeneration. In this paper, we review the different pulp states of young permanent teeth after trauma and the corresponding vital-pulp preservation treatment to provide a basis for oral clinicians to select the appropriate treatment stra-tegy.

Key words: tooth trauma, immature permanent teeth, dental-pulp state, vital pulp therapy

中图分类号: 

  • R781.33

表1

常见年轻恒牙外伤类型中不同牙髓状态下的治疗方案"

项目 硬组织损伤 牙周组织损伤
简单冠折 复杂冠/冠-根折 牙震荡 不完全脱位损伤 全脱位损伤 嵌入型损伤
保存
活髓
方式		 1）边缘磨光/充填修复;
2）牙本质封闭/间接盖髓+充填修复		 1）露髓孔直径<0.5 mm、时间短、断面干净：DPC[28];
2）露髓孔直径>0.5 mm、暴露时间长：活髓切断术		 定期监测牙髓状态,
牙髓坏死概率较小[13]		 定期监测牙髓状态,
可恢复牙髓血流供应[6]		 定期监测牙髓状态,
可恢复牙髓血流供应[6]		 定期监测牙髓状态,
牙髓坏死概率大[13]
随访
内容		 临床检查：牙冠颜色、叩诊、松动度、根尖周是否有窦道/瘘管、牙髓活力测试等 影像学检查：根尖周组织及牙根发育情况、是否存在牙根吸收、髓腔闭锁等
不良
结果
处理		 牙髓炎：根据炎症范围采用牙髓切断术[36] 牙髓坏死及根尖周病变：1）当牙根长度<2/3、根尖孔直径>1 mm时,行牙髓血运重建术[56];2）根尖孔直径0.5~1.0 mm、患牙有足够的根管壁厚度及长度,行根尖诱导成形术[45,46];3）牙根发育接近完成,根尖孔直径<0.5 mm或已行牙髓血运重建术及根尖诱导成形术后未形成明显根尖止点时,行根尖屏障术
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